Weir has exhausted her third and final avenue to appeal the insurer\u2019s internal decision to reject cover, but she hasn\u2019t given up yet, and plans to file a complaint with the Insurance & Financial Services Ombudsman Scheme. <\/p>\n
AIA chief customer officer Maddie Sherlock said the insurer was sorry for what Weir was going through and was not questioning her integrity, but her claim was declined in line with the terms and conditions of her policy. <\/p>\n
Sherlock said Weir had experienced breast-related symptoms which she was \u201crequired to disclose\u2019 for several weeks before her policy commencing, that led to further testing and a cancer diagnosis<\/a>.<\/p>\n Because of the \u201cclear link\u201d between pre-policy symptoms and the later diagnosis, the pre-existing condition exclusion applied which she was \u201crequired to disclose\u2019 \u2013 \u201cregardless of whether the underlying condition was diagnosed or suspected at the time\u201d.<\/p>\n \u201cWe recognise this is a very difficult situation for Sophie, and we understand she may wish to have the decision independently reviewed.\u201d<\/p>\n The diagnosis<\/p>\n Weir first approached a financial adviser about getting health coverage for herself and her family on October 1 last year, five months after giving birth to her youngest child.<\/p>\n \u201cIt was just like, \u2018Oh, we\u2019ve got a couple of kids, I should probably look into that\u2019. It seems like a smart thing to do if something went really wrong with our kids.\u201d<\/p>\n Shortly after, the adviser provided options for coverage, and late the following month, on November 27, her application for coverage at AIA insurance was approved and coverage began. <\/p>\n The following week, on December 1, she attended a GP appointment after experiencing weeks of breast engorgement in her right breast, a common issue for breastfeeding mothers.<\/p>\n Notes shared with the Herald by Weir show the doctor wrote she had presented with a breastfeeding complaint and had experienced pain in her right breast for two days, engorgement for five weeks and showed mild redness.<\/p>\n She told the Herald she had never noticed the redness and said the five weeks were a rough estimate.<\/p>\n The notes said no specific lump or abscess was identified, and the GP\u2019s impression of her condition was \u201clactational mastitis\u201d. Weir was prescribed antibiotics. <\/p>\n She also spoke to a Plunket worker about her breast on November 28. Notes from the call said she had experienced pain on one side for five weeks.<\/p>\n \u201cBaby is six months but maybe not totally emptying the breast and will only feed for 10 minutes,\u201d the Plunket worker wrote.<\/p>\n They also noted Weir was not sure if her baby was getting enough milk from that breast or whether this was something she should raise with her doctor. <\/p>\n It was recommended that she start feeds on her sore breast as the baby sucked strongest on the first side.<\/p>\n The worker recommended commencing a gentle breast massage toward the nipple during feeding, using a cold pack and trying different feeding holds. <\/p>\n Checking for latching issues, using pain relief and a warm shower if needed, were also recommended.<\/p>\n If symptoms worsened she was advised to see her GP.<\/p>\n Weir said these were common strategies to prevent mastitis from developing.<\/p>\n \u201cWhat often happens is that you have a blocked duct, which is what I thought was happening, and that can develop into mastitis.\u201d<\/p>\n Weir felt she did not need to worry; she knew her breast engorgement symptoms were common and she\u2019d seen lactation consultants who had not raised any concerns.<\/p>\n However, when her breast symptoms had still not settled four days after her GP appointment, she was referred for an ultrasound because her mastitis was not responding \u201cas expected\u201d and she had a \u201cpossible abscess\u201d. <\/p>\n Two days later, on December 7, she visited a hospital emergency department after feeling unwell and a doctor there did not believe it was mastitis and escalated her care. <\/p>\n \u201cNo one said the C-word, the doctor just said, \u2018You need an urgent mammogram\u2019, then I read between the lines. <\/p>\n \u201cI acted on it right away, it wasn\u2019t like I was scared of getting results or avoiding the diagnosis. I was like, \u2018Oh no, if it is cancer I want to know right away\u2019.<\/p>\n \u201cI just had this gut feeling and it sucked because my mum picked me up from ED that day and I looked at her and I just said, \u2018I\u2019ve got to get a mammogram\u2019, and we both kind of teared up and knew.\u201d<\/p>\n About two weeks on from her initial GP appointment, it was confirmed. She had breast cancer. <\/p>\n The lump was 10cm by 6cm. <\/p>\n \u201cIt was massive. When you think about the size of that, it\u2019s not like a little lump, it\u2019s a large mass. So when you\u2019re pressing around your boob looking for a lump you probably wouldn\u2019t feel it anyway because it\u2019s so big.\u201d <\/p>\n She started chemotherapy on New Year\u2019s Eve 2025 and after completing her sixth round, she underwent surgery to remove her breast this week. <\/p>\n \u2018Yikes… Timing\u2019s not great\u2019<\/p>\n Weir said she first learned there could be an issue with her insurance coverage when she notified her financial adviser that she was having tests.<\/p>\n \u201cOh I think I\u2019ve got something serious on my hands,\u201d she told the adviser about the time of the mammogram.<\/p>\n \u201cShe was like, \u2018Yikes, the timing\u2019s not great\u2019,\u201d and indicated there could be a problem.<\/p>\n While Weir is now being treated in the public system, she went through the diagnosis process, her initial round of chemo and received some medication privately, setting her family back about $35,000. <\/p>\nSophie Weir believes other women need to know about her case. Photo \/ Annaleise Shortland<\/p>\n
Sophie Weir in the chair for her last dose of chemotherapy. Photo \/ Supplied<\/p>\n